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Hypothermia

• Signs and Symptoms
• What Causes It?
• Who's Most At Risk?
• What to Expect at Your Provider's Office
• Treatment Options
• Prognosis and Possible Complications
• Following Up
• Supporting Research

Hypothermia results from an abnormally low body temperature, which causes the circulatory, respiratory, and nervous systems to slow down. Body temperature is a balance between how much heat is produced and how much heat is lost, with the brain acting as the thermostat. Severe hypothermia can cause an irregular heartbeat, which can lead to heart failure and possibly death. Over 700 deaths occur annually from hypothermia in the United States.

Signs and Symptoms

The following signs and symptoms accompany hypothermia:

• Skin that is cold to the touch
• Absence of shivering
• Lethargy, drowsiness
• Weakness, clumsiness
• Irritability, combativeness
• Confusion, delirium, hallucinations
• Slow reflexes
• Seizure, stupor, or coma
• Slowed, shallow, or arrested breathing
• Slowed, irregular, or arrested heartbeat

What Causes It?

Hypothermia can happen from accidental exposure to cold, to immersion in cold water, or to trauma from a serious accident. In the elderly, hypothermia may develop over hours or days as a result of poor body heat regulation, inability to properly sense the cold, or living in a cold environment in the winter. Diseases of the endocrine glands may also cause a decrease in heat production in the body.

Who's Most At Risk?

The following factors can cause hypothermia:

• Exposure to cold.
• Immersion in cold water.
• Severe trauma, especially brain injury or burns.
• Immobilization (not moving for long periods).
• Age-related physical problems. Over half of all hypothermia-related deaths occur in people over age 65.
• Pre-existing disease such as heart failure, pulmonary infection, other toxic infections, or endocrine disorders.
• Dehydration.
• Drugs such as alcohol, tranquilizers, sedatives, hypnotics, or antipsychotics.
• Poverty, malnutrition, or homelessness.
• Social isolation or mental illness.

What to Expect at Your Provider's Office

Severe hypothermia is a life-threatening condition. If you or someone you care for is experiencing symptoms associated with hypothermia that cannot be easily reversed, call the Emergency Assistance Number, 9-1-1, immediately.

Treatment Options

Prevention

You can usually prevent hypothermia by preparing appropriately for environmental conditions and recognizing the early symptoms. If you plan to be outdoors for extended periods in cold weather, wear insulated or layered moisture-wicking clothing, including headgear. Avoid overexertion, eat enough food, drink enough fluids, and do not drink alcohol. People who are prone to hypothermia, such as the elderly or the homeless, can receive assistance from social service agencies to help them find adequate housing, heat, and clothing.

Treatment Plan

Mild hypothermia can be treated by warming the affected person. Wet clothing should be removed and replaced with dry, warm clothing and blankets. Other techniques include using hot water bottles, warm baths, or heat packs placed under the arms and on the chest, neck, and groin.

In severe cases, if breathing and heartbeat have stopped, the person should not be considered dead until efforts have first been made by health care professionals to warm the individual.

At the hospital, the medical team will use heated intravenous fluids. The person may be wrapped with blankets in a warm room or put into a large tub of warm water.

Drug Therapies

In severe or complicated cases of hypothermia, intravenous drug therapy may be used.

Complementary and Alternative Therapies

Nutritional measures can help prevent hypothermia. Animal studies suggest that Western and Chinese herbal therapies influence body temperature and may help prevent hypothermia if used before, or just after, exposure to cold. Depending on results from future scientific studies, they may also help treat hypothermia.

Always tell your health care provider about the herbs and supplements you are using.

Nutrition and Supplements

Following these nutritional tips may help reduce symptoms of cold exposure:

• Eat warming spices in your foods, such as basil, ginger, turmeric, garlic, and cayenne.
• Eat antioxidant foods, including fruits (such as blueberries, cherries, and tomatoes), and vegetables (such as squash and bell peppers).
• Eat more hot soups made with fresh vegetables.
• Avoid refined foods such as white breads, pastas, and especially sugar.
• Eat fewer red meats and more lean meats, cold-water fish, tofu (soy, if no allergy) or beans for protein.
• Use healthy cooking oils, such as olive oil or vegetable oil.
• Reduce or eliminate trans-fatty acids, found in commercially baked goods such as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.
• Avoid coffee and other stimulants, alcohol, and especially tobacco. Tobacco causes constriction of blood vessels and may increase susceptibility to hypothermia.
• Drink 6 - 8 glasses of filtered water daily. Hydration is very important in decreasing cold exposure problems.
• Exercise at least 30 minutes daily, 5 days a week.

Nutritional deficiencies may be addressed with the following supplements:

• A multivitamin daily, containing the antioxidant vitamins A, C, E, the B-vitamins and trace minerals, such as magnesium, calcium, folic acid, zinc, and selenium.
• Omega-3 fatty acids, such as fish oil, 1 - 2 capsules or 1 tablespoonful oil one to two times daily, to help decrease inflammation and improve immunity. Cold-water fish, such as salmon or halibut, are good sources.
• Coenzyme Q10, 100 - 200 mg at bedtime, for antioxidant, heart, and muscular support.
• Alpha-lipoic acid, 25 - 50 mg twice daily, for antioxidant support.
• L-theanine, 200 mg one to three times daily, for stress and nervous system support.

Herbs

Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider to get your problem diagnosed before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, you should make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day. You may use tinctures alone or in combination as noted.

• Panax ginseng ( Panax ginseng ) standardized extract, 100 - 200 mg twice daily, for preventing symptoms of cold exposure. You can also prepare teas from this herb.
• Green tea ( Camellia sinensis ) standardized extract, 250 - 500 mg daily, for antioxidant, anti-inflammatory and cold protective effects. Use caffeine free products. You may also prepare teas from the leaf of this herb.
• Bilberry ( Vaccinium myrtillus ) standardized extract, 80 mg two to three times daily, for antioxidant and vascular system support.
• Ginkgo ( Ginkgo biloba ) standardized extract, 40 - 80 mg three times daily, for antioxidant support and cold protection.

Herbal teas may help in decreasing symptoms of cold exposure. Use herbs such as chamomile ( Matricaria chamomilla ), green tea ( Camellia sinensis ) and ginger ( Zingiber officinalis ).

Homeopathy

Few studies have examined the effectiveness of specific homeopathic remedies. A professional homeopath, however, may recommend one or more of the following treatments for hypothermia based on their knowledge and clinical experience. Before prescribing a remedy, homeopaths take into account a person’s constitutional type -- your physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual.

• Aconitum -- very useful remedy when used just following exposure to cold, including in cases of shock and when extremities are cold, tingling, or numb.
• Arnica -- important homeopathic remedy for first aid, particularly in the case of shock and following trauma.
• Carbo vegetabilis -- for icy cold, bluish skin, particularly when the person is weak, sluggish, close to fainting, and short of breath.
• Cuprum metallicum -- for bluish discoloration of the skin accompanied by muscle cramps

Acupuncture

Caution must be exercised when using acupuncture to treat fever. Stimulating certain acupuncture points with needles can produce hypothermia by decreasing the heat from metabolism (chemical processes in your body) and by dilating blood vessels in the skin.

Massage

Massage should not be used in the case of hypothermia. Massage may dilate the blood vessels on the surface of the body, drawing blood away from the core and vital organs such as the heart and the brain. During hypothermia, this may cause your circulatory system to collapse.

Prognosis and Possible Complications

People with mild hypothermia have an excellent prognosis. However, people with moderate to severe hypothermia can face serious complications and even death. Children are more likely to recover from severe hypothermia than adults. The mortality rate for hypothermia in the elderly is about 50%. There are many possible complications from hypothermia, including hypoxia (lack of oxygen in the tissues), gangrene in the hands and feet, inflammation of the pancreas, fluid in the lungs, pneumonia, kidney failure, and heart irregularities.

Following Up

Those who have severe hypothermia should be hospitalized; if necessary, cardiopulmonary resuscitation will be performed. A hypothermic patient should be transported very carefully as there is a tendency toward irregular heartbeat that could be fatal. Normal body temperature in the elderly should be restored slowly, or permanent low blood pressure may result. All people with hypothermia must be closely monitored until their body temperature returns to normal.

Supporting Research

Ahlemeyer B, Krieglstein J. Neuroprotective effects of Ginkgo biloba extract. Cell Mol Life Sci . 2003;60(9):1779-92.

Beers MH, Berkow R, eds. The Merck Manual of Diagnosis and Therapy . Whitehouse Station, NJ: Merck & Co. 1999:2451-2452, 2507-2508.

Bell DR, Gochenaur K. Direct vasoactive and vasoprotective properties of anthocyanin-rich extracts. J Appl Physiol . 2006;100(4):1164-70.

Blumenthal M, ed. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines . Boston, Mass: Integrative Medicine Communications; 1998:138-139, 142-143, 148-149, 197.

Blumenthal M, Goldberg A, Brinckmann J, eds. Herbal Medicine: Expanded Commission E Monographs . Newton, Mass: Integrative Medicine Communications; 2000:106-109, 170-177.

Cabrera C, Artacho R, Gimenez R. Beneficial effects of green tea--a review. J Am Coll Nutr . 2006;25(2):79-99.

Centers for Disease Control and Prevention. Hypothermia-related deaths: Georgia, January 1996–December 1997, and United States, 1979–1995. MMWR Morb Mortal Wkly Rep. 1998;47:1037-1040.

Cummings S, Ullman D. Everybody's Guide to Homeopathic Medicines. 3 ^rd ed. New York, NY: Penguin Putnam; 1997: 297, 318-319.

Fontani G, Corradeschi F, Felici A, et al. Cognitive and physiological effects of Omega-3 polyunsaturated fatty acid supplementation in healthy subjects. Eur J Clin Invest . 2005;35(11):691-9.

Gaby AR. The role of coenzyme Q10 in clinical medicine: Part 1. Alt Med Rev . 1996; 1(1):11-17.

Hayward JS, Eckerson JD, Kemna D. Thermal and cardiovascular changes during three methods of resuscitation from mild hypothermia. Resuscitation . 1984;11:21-33.

Jonas WB, Jacobs J. Healing with Homeopathy: The Doctors' Guide. New York, NY: Warner Books; 1996: 254-258.

Kimura K, Ozeki M, Juneja LR, Ohira H. l-Theanine reduces psychological and physiological stress responses. Biol Psychol . 2006 Aug 21.

LaValle JB, Krinsky DL, Hawkins EB, et al. Natural Therapeutics Pocket Guide . Hudson, OH:LexiComp; 2000: 452-454.

Lin MT, Chandra A, Chen-Yen SM, Chern YF. Needle stimulation of acupuncture loci chu-chih (LI-11) and ho-ku (LI-4) induces hypothermia effects and analgesia in normal adults. Am J Chin Med . 1981;9(1):74-83.

Murray JE, Pizzorno MT, eds. Textbook of Natural Medicine . Edinburgh: Churchill Livingstone; 1999: 531.

Ramachandran U, Divekar HM, Grover SK, Srivastava KK. New experimental model for the evaluation of adaptogenic products. J Ethnopharmacol . 1990 Jul;29(3):275-81.

Rotsein OD. Oxidants and antioxidant therapy. Crit Care Clin . 2001;17(1):239-47.

Semenza JC, McCullough JE, Flanders WD, McGeehin MA, Lumpkin JR. Excess hospital admissions during the July 1995 heat wave in Chicago. Am J Prev Med 1999;16(4):269-277.

Simopoulos AP. Omega-3 fatty acids in inflammation and autoimmune diseases. J Am Coll Nutr . 2002;21(6):495-505.

Ullman D. The Consumer's Guide to Homeopathy. New York, NY: Penguin Putnam; 1995: 326.

Wang HK. The therapeutic potential of flavonoids. Expert Opin Investig Drugs . 2000;9(9):2103-19.Weinberg AD. Hypothermia. Ann Emerg Med . 1993;22 (Pt 2):370-377.

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• Review Date: 9/5/2006
• Reviewed By: Ernest B. Hawkins, MS, BSPharm, RPh, Health Education Resources; and Steven D. Ehrlich, N.M.D., private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

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